Are Kids Safer in States with Stricter Gun Laws?

Regional differences exist in pediatric firearm-related injuries

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Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

CHICAGO -- Regions of the country with stronger firearm restrictions had fewer children admitted to the emergency department (ED) with firearm injuries, researchers said here.

A higher regional Brady Gun Law Score was linked with significantly lower rates of firearm-related ED visits in children, with the Northeast having the lowest rate compared to other U.S. regions, reported Shilpa Patel, MD, of George Washington University in Washington, and colleagues.

Firearm injury is a leading cause of morbidity and mortality in children, but that prior studies about the impact of gun laws on patient injury included adults and children, she said in a presentation at the American Academy of Pediatrics (AAP) annual meeting.

"Studies limited to the impact of firearm legislation on pediatric injury are scarce," Patel stated.

Her group performed a repeated cross-sectional analysis using both 5 years of data from the Nationwide Emergency Department Sample, which estimates firearm-related visits to EDs for patients under age 21 years by census region (Northeast, South, West and Midwest). In this case, “pediatric” patients were defined as age 21 and younger.

They then compiled Brady Gun Law Scores, which are measured on a state level, into median regional scores. Brady Gun Law Scores are designed to objectively measure the strictness of gun laws. They examine such measures as strength of background checks, limitation on assault-style weapons, and restriction of firearms in public, as determined by an expert panel, and are scored from 0 to 100.

Regional median Brady Gun Law Scores were 44 for the Northeast, 9 for the Midwest and West, and 8 for the South.

From 2009 to 2013, there were 111,839 ED visits for pediatric firearm injuries. Patient median age was 18 years, and almost 90% were men, with 92% treated in an urban hospital. Only 21% had private insurance. Of these patients, a little over half were discharged, 30% were admitted, 10% were transferred, and 6% died.

Patel noted that the majority of all firearm-related ED visits were due to accidental firearm injury, including over three-quarters of those among children under age 15 years.

Rates of firearm-related injuries remained consistent from 2009 to 2012 (65 per 100,000 ED visits), but there was a significant drop in 2013 (51 per 100,000, P=0.048). The rates of firearm-related pediatric ED visits varied by region. The Northeast had the lowest rate (40 per 100,000 ED visits), followed by the Midwest (62 per 100,000), the West (68 per 100,000) and the South (71 per 100,000).

There was an almost two-fold increased risk of firearm-related ED visits in the South (adjusted OR 1.8, 95% CI 1.4-2.3) and the West (adjusted OR 1.9, 95% CI 1.3-2.2) compared with the Northeast.

However, Patel acknowledged that Brady Gun Law scores are not a validated score, but that she was "unaware of any validated scoring system for firearm legislation." She added that this was an "ecologic study," so they were unable to establish causality.

An AAP attendee also took issue with the regional score, specifically for the West, pointing out that "California has over 100 gun laws on the books, while Utah has three." Patel responded they were considering further research that examined state-level data.

A second presentation by Sheryl Yanger, MD, of Ann & Robert H. Lurie Children's Hospital of Chicago, found that only around a third of pediatricians provided counsel about firearm injury prevention when discussing other types of pediatric injury prevention, like helmet use and child seat safety, with their patients.

Yanger's group surveyed members of the AAP Section on Emergency Medicine. Of the 118 respondents, nearly all were attending physicians, and the majority had completed a fellowship in pediatric emergency medicine, and practiced in academic university-based, urban, free-standing children's hospitals. Three-quarters of clinicians identified as Democrats, and about 12% said they owned a firearm in their home.

Clinicians were more significantly likely to provide firearm safety to their patients if they felt it was their "responsibility" to counsel on firearm safety (adjusted OR 5.13), had "confidence" in their ability to provide firearm injury prevention information (aOR 4.05) or were younger than age 45 (aOR 3.37).

They reported barriers to firearm safety counseling, including "political restraints, lack of awareness, and legal constraints," with a third of clinicians "unsure if their state permitted them to have discussions about firearms."

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